The literature on oral sugar-electrolyte mixtures for treatment of acute diarrhoea is reviewed. Several trials have shown that the solution proposed by the WHO for developing countries containing inter alia 90 mmol/l of sodium and 111 mmol/l of glucose is safe for short term oral rehydration. When used in this manner there is no risk for development of hypernatraemia. The surplus base of the solution is not essential and, furthermore, other anions e.g. acetate may be substitute for bicarbonate. Other modifications of the WHO formula have also been successfully tried, e.g. sucrose 4% (117 mmol/l) instead of glucose 2% (111 mmol/l). A somewhat lower concentration of sucrose may, however, prove to be better. Most acute childhood diarrhoeas are not mediated by enterotoxin and thus not of the secretory type, but temporary malabsorption is common. Therefore, the amount of carbohydrate in oral sugar-electrolyte mixtures should be limited. Osmotic diarrhoea due to carbohydrate malabsorption is a more likely cause of hypernatraemia in dehydrated children than too much dietary sodium. In developed countries prepacked oral sugar-electrolyte mixtures are mainly designed for moderately sick children treated at home. There is no reason to raise the carbohydrate content of these mixtures above that of the WHO formula, but the sodium content must be lower. For most situations in home treatment 50 mmol/l of sodium will be adequate.

High sugar worse than high sodium in oral rehydration solutions

531 of observation were available for analysis. In total, 46 women had been diagnosed during the follow up period by the consultant responsible for their care as suffering from a first stroke (ICD (8th revision) codes 430-438). Thirteen had suffered a subarachnoid haemorrhage, of whom four died; eight had an aneurysm or arteriovenous malformation detected by angio-graphy or at necropsy. Two other women (who are not considered further here) suffered definite intracranial haemorrhage (a fatal intracerebral haemorrhage in one and a chronic bilateral subdural haematoma in the other). The remaining 31 women developed strokes of thrombotic, embolic, or unknown pathogenesis (hereafter referred to as \"non-haemorrhagic\" strokes). Of these 31, only two died, while so far as could be ascertained from the available records another nine were left with an important disability. Arteriography or brain scanning was undertaken in 17 women and an abnormality was found in nine. The diagnosis of stroke in the non-haemorrhagic group was thus usually on the basis of the clinical picture. We analysed the data concerning subarachnoid haemorrhage and non-haemorrhagic stroke separately, taking into account the woman's age, whether or not she had been referred to hospital for management of hyper-tension before the stroke occurred, her smoking habits, and her use of oral contraceptives. The table summarises the results. Numbers were small, but the data suggest that hypertension and smoking were strongly related and that pill use was weakly related to the risk of subarachnoid haemorrhage. Incidence of suibarachnoid haemorrhage and \"non-haemorrhagic\" stroke in relation to age, history of hospital referral for hypettension, cigarette smoking, and oral contraceptive use. (Data given for each variable adjusted for effects of all other variables by indirect standardisation)

https://www.bmj.com/content/bmj/289/6444/531.full.pdf

Polymicrobial septicaemia due to Clostridium difficile and Bacteroides fragilis.

Diarrhoeal Diseases in Low- and Middle- income Countries

Clinical trials testing different oral rehydration solutions (ORS) are reviewed. The effects of individual components and their concentrations are analysed in order to establish margins of safety for the composition of the ideal ORS for children in Europe. Glucose is the solute of choice for ORS and concentrations of 70-140 mmol/l are adequate. Glucose may be replaced by sucrose or glucose polymers. "Low" sodium concentrations (35-60 mmol/l) are advised for rehydration and maintenance in acute non-cholera diarrhoea, for children of all ages, including neonates, and for any degree of dehydration except shock. Although intended for children who are not malnourished, the European ORS should have an adequate potassium concentration (20-30 mmol/l), namely the same concentration as found in WHO-ORS. Chloride concentration depends upon other constituents of ORS, namely sodium and potassium, but the range of 30-90 mmol/l is considered to be adequate. Base or base precursors are not required for correction of acidosis except in the severe cases that always need intravenous replacement. A relatively low osmolality seems advisable.

Optimising Oral Rehydration Solution Composition for the Children of Europe: Clinical Trials

Acute diarrhoea is an important health problem in developed countries, particularly in young children. The attack rates for viral diarrhoea are similar in developed and developing countries. Rotavirus is the most common pathogen, followed by adenovirus. Bacterial diarrhoea is less common in developed than developing countries. The 2 most common bacterial pathogens are Campylobacter jejuni and Salmonella. The most serious consequence of diarrhoea is dehydration, and the treatment for this is the same whatever the pathogen. Recently, there have been major changes in the management of diarrhoea with emphasis on oral rehydration and early feeding. Two controversial areas are the sodium content of solutions designed for developed countries and the best route of administration of fluids to children with moderately severe dehydration. There have been 4 randomised controlled trials in developed countries comparing oral and intravenous rehydration. The findings have confirmed the experience in developing countries that most children without shock can be rehydrated orally, thus substantially reducing the need for intravenous fluids. It is important to give physiologically balanced solutions which contain 2% glucose and 50 to 90 mmol/L of sodium. Many of the commercially available oral solutions are appropriate for rehydration and maintenance ofhydration in infants with diarrhoea of all types. They are recommended particularly for the prevention of dehydration in children of all ages with severe diarrhoea and for the treatment of dehydration. Children with mild diarrhoea and no dehydration can be given commercial clear fluids diluted with water, or homemade solutions made with table sugar and water. Salt must not be used. Babies should continue on breast milk or formula with extra water. Education is the key to successful oral rehydration, and the ultimate aim should be the prevention of dehydration.

Oral rehydration in infantile diarrhoea in the developed world.

Four different carbohydrate electrolyte solutions were provided for children under 18 months with acute gastroenteritis treated as outpatients. Osmolality and sodium content were measured in samples of solutions as given by the parents. All types of feed were made up with marked inaccuracy. Osmolality was sometimes unacceptably high in solutions containing glucose, while the highest osmolality for sucrose solutions hardly exceeded the correct value for glucose solutions. Most parents could use a sachet with reasonable accuracy although there were still wide extremes of errors. The ideal preparation for use in developed countries may be a sachet containing sucrose and electrolyte, particularly if such sachets could be made generally available and not just for use in hospitals and clinics.

https://adc.bmj.com/content/archdischild/55/8/616.full.pdf

Oral solutions for infantile gastroenteritis--variations in composition.

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Oral solutions for infantile gastroenteritis--variations in composition.